ICDDRGX ;ALB/EG/MRY/ADL/KUM/JDG - GROUPER PROCESS ;08/04/2015
;;18.0;DRG Grouper;**1,2,5,7,10,14,20,24,27,31,64,82**;Oct 20, 2000;Build 21
;
CKHIV ;MDC25 grouping
N ICDI
I ICDDATE>3070930.9 G CKHIV^ICDDRGXM ;MS-DRG
;Q:ICDP25=""
I ICDPD'["h"&(ICDSD'["h") Q
S ICDRG=$S(ICDOR["x":488,ICDPD["i"&($D(ICDS25(1))):490,1:ICDRG)
S ICDGH=$S("488^489^490"[ICDRG:1,1:0),ICDORNI=$S(ICDOCNT>0:ICDORNI,1:0),ICDORNA=$F(ICDORNI,"O",$F(ICDORNI,"O"))
S:ICDORNI="" ICDORNI=ICDOR
S ICDRG=$S(ICDP25=1&(ICDORNA>0):488,1:ICDRG) I 'ICDGH&(ICDRG=488) Q
S:(ICDOCNT>0) ICDRG=$S(ICDP25>1&(ICDORNA>0)&($D(ICDS25(1))):488,1:ICDRG) I 'ICDGH&(ICDRG=488) Q
I ICDOPCT>0 D I ICDRG=488 Q
.;count the non-extensive "z" vs the "O"
.N K1,K2,I
.S (K1,K2)=0
.F I=1:1:$L(ICDORNI) S:$E(ICDORNI,I,I)="z" K1=K1+1 S:$E(ICDORNI,I,I)="O" K2=K2+1
.I ICDP25=1!(ICDP25>1&($D(ICDS25)>0)) D
..I K1<K2&(K1<ICDOPCT) D
...S ICDRG=488 Q
..I ICDOPCT=1&(ICDORNI'["z") D
...S ICDRG=488 Q
S ICDRG=$S(ICDP25=1&('$D(ICDS25))&('$$EXIST^ICDEX(ICDDX(1),30)):490,1:ICDRG) I 'ICDGH&(ICDRG=490) Q
S ICDRG=$S(ICDP25=1&($D(ICDS25(2))):489,ICDP25=1&($D(ICDS25(3))):490,1:ICDRG) I 'ICDGH&((ICDRG=489)!(ICDRG=490)) Q
S ICDRG=$S(ICDP25=2&($D(ICDS25(1))):489,ICDP25=3&($D(ICDS25(1))):490,1:ICDRG) I 'ICDGH&((ICDRG=489)!(ICDRG=490)) Q
S ICDRG=$S((ICDP25&(ICDOCNT=0)&('$D(ICDS25))):490,1:ICDRG) I 'ICDGH&(ICDRG=490) Q
S:(ICDRG=488)!(ICDRG=489)!(ICDRG=490) ICDRTC=0
K ICDGH,ICDP25,ICDS25,ICDORNA Q
CKMST ;MDC24 grouping; MS-DRG additions
S ICDAJ=0 F ICDS24K=1:1 S ICDAJ=$O(ICDS24(ICDAJ)) Q:ICDAJ=""
S ICDS24K=ICDS24K-1,ICDS24L=0 F ICDI=1:1:8 S:$D(ICDS24(ICDI))&(ICDI'=ICDP24) ICDS24L=$S($D(ICDS24(ICDI)):1,1:0)
I ICDOR["u" S ICDS24K=ICDS24K+1
G:((ICDP24=0)&(ICDS24K<2))!((ICDP24>0)&('ICDS24L)) CKMSTE
N CKMST S CKMST=0
I ICDDATE>3070930.9 D Q:CKMST ;MS-DRG
. S ICDRG=$S(ICDP24=0&(ICDS24K>1)&($D(ICDO24(1))):955,ICDP24>0&($D(ICDO24(1)))&(ICDS24L):955,1:ICDRG) I ICDRG=955 D CKMSTE S CKMST=1 Q
. S:ICDRG'=955 ICDRG=$S(ICDP24=0&(ICDS24K>1)&($D(ICDO24(2))):956,ICDP24>0&($D(ICDO24(2)))&(ICDS24L):956,1:ICDRG) I ICDRG=956 D CKMSTE S CKMST=1 Q
. S:ICDRG'=956 ICDRG=$S(ICDP24=0&(ICDS24K>1)&($D(ICDO24(3))):959,ICDP24>0&($D(ICDO24(3)))&(ICDS24L):959,1:ICDRG) I ICDRG=959 D CKMSTE S CKMST=1 Q
. S ICDRG=$S(ICDP24=0&(ICDS24K>1):965,ICDP24>0&ICDS24L:965,1:ICDRG)
. S:(ICDRG>954)&(ICDRG<966) ICDRTC=0
E D Q:CKMST ;CMS-DRG
. S ICDRG=$S(ICDP24=0&(ICDS24K>1)&($D(ICDO24(1))):483,ICDP24>0&($D(ICDO24(1)))&(ICDS24L):483,1:ICDRG) I ICDRG=483 D CKMSTE S CKMST=1 Q
. S:ICDRG'=483 ICDRG=$S(ICDP24=0&(ICDS24K>1)&($D(ICDO24(2))):485,ICDP24>0&($D(ICDO24(2)))&(ICDS24L):485,1:ICDRG) I ICDRG=485 D CKMSTE S CKMST=1 Q
. S:ICDRG'=485 ICDRG=$S(ICDP24=0&(ICDS24K>1)&($D(ICDO24(3))):486,ICDP24>0&($D(ICDO24(3)))&(ICDS24L):486,1:ICDRG) I ICDRG=486 D CKMSTE S CKMST=1 Q
. S ICDRG=$S(ICDP24=0&(ICDS24K>1):487,ICDP24>0&ICDS24L:487,1:ICDRG)
. S:(ICDRG>482)&(ICDRG<488) ICDRTC=0
CKMSTE K ICDAJ,ICDP24,ICDS24,ICDO24,ICDS24K,ICDO24,ICDS24L
Q
CKNMDC ;non MDC drg's
I ICDDATE>3070930.9 G CKNMDC^ICDDRGXM ;MS-DRG
S:(ICDRG>479)&(ICDRG<483) ICDRG=470
; ICD*18*1 - reorder drg 103 higher than all Pre-MDCs 480-83 & 495
I ICDRG=103 S ICDRTC=0 Q
S ICDCDSY=$S(ICDDATE'<$$IMPDATE^LEXU("10D"):30,1:1)
;use FY logic to resolve DRG if no FY defined user current FY
N ICDDXFY S ICDDXFY=""
I ICDDATE>3040930.9 D I ICDRG=541!(ICDRG=542) S ICDRTC=0 Q ;Use DRG FY 05 logic
.;S ICDRG=$S($D(ICDOP(" 31.1"))!($D(ICDOP(" 31.21")))!($D(ICDOP(" 31.29")))&(($P($$ICDDX^ICDCODE(ICDDX(1),ICDDATE),"^",3)'["Y")!($D(ICDOP(" 96.72")))):541,1:ICDRG)
.;I ICDRG=541&(($P($$ICDDX^ICDCODE(ICDDX(1),ICDDATE),"^",3))["Y") S ICDRG=542 S ICDRTC=0
.I $D(ICDOP(" 39.65")) S ICDRG=541 Q
.I $D(ICDOP(" 31.1"))!($D(ICDOP(" 31.21")))!($D(ICDOP(" 31.29"))) I $TR($P($$ICDDX^ICDEX(ICDDX(1),ICDDATE,ICDCDSY,"I"),"^",3),";","")'["Y"!(($D(ICDOP(" 96.72")))) S ICDRG=542
.I $D(ICDOP(" 31.1"))!($D(ICDOP(" 31.21")))!($D(ICDOP(" 31.29"))) I $TR($P($$ICDDX^ICDEX(ICDDX(1),ICDDATE,ICDCDSY,"I"),"^",3),";","")'["Y"!(($D(ICDOP(" 96.72")))) I ICDOR["O"&(ICDOR'["z")&(ICDOR'["y") S ICDRG=541
I ICDDATE<3041001 D Q:ICDRG=483 ;Use DRG FY 04 logic
.S ICDRG=$S($D(ICDOP(" 31.1"))!($D(ICDOP(" 31.21")))!($D(ICDOP(" 31.29")))&(($TR($P($$ICDDX^ICDEX(ICDDX(1),ICDDATE,ICDCDSY,"I"),"^",3),";","")'["Y")!($D(ICDOP(" 96.72")))):483,1:ICDRG) I ICDRG=483 S ICDRTC=0
S ICDRG=$S(ICDOR["l":480,1:ICDRG) I ICDRG=480 S ICDRTC=0 Q
I ICDRG=512!(ICDRG=513) S ICDRTC=0 Q
S ICDRG=$S(ICDOR["r":495,1:ICDRG) I ICDRG=495 S ICDRTC=0 Q ;check for lung tx
S ICDRG=$S(ICDOR["q":103,1:ICDRG) I ICDRG=103 S ICDRTC=0 Q ;check for heart tx
S ICDRG=$S(ICDOR["B":481,1:ICDRG) I ICDRG=481 S ICDRTC=0 Q
S ICDRG=$S($D(ICDOP(" 30.3"))!$D(ICDOP(" 30.4")):482,1:ICDRG) I ICDRG=482 S ICDRTC=0 Q
S ICDRG=$S(ICDOR["t"&($TR($P($$ICDDX^ICDEX(ICDDX(1),ICDDATE,ICDCDSY,"I"),"^",3),";","")["Y"):482,1:ICDRG) I ICDRG=482 S ICDRTC=0 Q
Q
;
;
CHKMDC4 ;MDC 4 drg's
I ICDDATE>3070930.9 D ;MS-DRG
. I (ICDMDC=4!(ICDMDC=98)),(ICDOR["f") S ICDRG=168
. I ICDDRG=983,$G(ICDMDC)=5,$D(ICDOP(" 86.06")) S ICDRG=264
. I ICDDRG=983,$G(ICDMDC)=5,$D(ICDOP(" 92.27")),ICDNOR=1 S ICDRG=264 ;ICD*18*5
E D ;CMS-DRG
. I (ICDMDC=4!(ICDMDC=98)),(ICDOR["f") S ICDRG=76
. I ICDDRG=468,$G(ICDMDC)=5,$D(ICDOP(" 86.06")) S ICDRG=120
. I ICDDRG=468,$G(ICDMDC)=5,$D(ICDOP(" 92.27")),ICDNOR=1 S ICDRG=120 ;ICD*18*5
Q
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HICDDRGX 5435 printed Dec 13, 2024@01:50:23 Page 2
ICDDRGX ;ALB/EG/MRY/ADL/KUM/JDG - GROUPER PROCESS ;08/04/2015
+1 ;;18.0;DRG Grouper;**1,2,5,7,10,14,20,24,27,31,64,82**;Oct 20, 2000;Build 21
+2 ;
CKHIV ;MDC25 grouping
+1 NEW ICDI
+2 ;MS-DRG
IF ICDDATE>3070930.9
GOTO CKHIV^ICDDRGXM
+3 ;Q:ICDP25=""
+4 IF ICDPD'["h"&(ICDSD'["h")
QUIT
+5 SET ICDRG=$SELECT(ICDOR["x":488,ICDPD["i"&($DATA(ICDS25(1))):490,1:ICDRG)
+6 SET ICDGH=$SELECT("488^489^490"[ICDRG:1,1:0)
SET ICDORNI=$SELECT(ICDOCNT>0:ICDORNI,1:0)
SET ICDORNA=$FIND(ICDORNI,"O",$FIND(ICDORNI,"O"))
+7 if ICDORNI=""
SET ICDORNI=ICDOR
+8 SET ICDRG=$SELECT(ICDP25=1&(ICDORNA>0):488,1:ICDRG)
IF 'ICDGH&(ICDRG=488)
QUIT
+9 if (ICDOCNT>0)
SET ICDRG=$SELECT(ICDP25>1&(ICDORNA>0)&($DATA(ICDS25(1))):488,1:ICDRG)
IF 'ICDGH&(ICDRG=488)
QUIT
+10 IF ICDOPCT>0
Begin DoDot:1
+11 ;count the non-extensive "z" vs the "O"
+12 NEW K1,K2,I
+13 SET (K1,K2)=0
+14 FOR I=1:1:$LENGTH(ICDORNI)
if $EXTRACT(ICDORNI,I,I)="z"
SET K1=K1+1
if $EXTRACT(ICDORNI,I,I)="O"
SET K2=K2+1
+15 IF ICDP25=1!(ICDP25>1&($DATA(ICDS25)>0))
Begin DoDot:2
+16 IF K1<K2&(K1<ICDOPCT)
Begin DoDot:3
+17 SET ICDRG=488
QUIT
End DoDot:3
+18 IF ICDOPCT=1&(ICDORNI'["z")
Begin DoDot:3
+19 SET ICDRG=488
QUIT
End DoDot:3
End DoDot:2
End DoDot:1
IF ICDRG=488
QUIT
+20 SET ICDRG=$SELECT(ICDP25=1&('$DATA(ICDS25))&('$$EXIST^ICDEX(ICDDX(1),30)):490,1:ICDRG)
IF 'ICDGH&(ICDRG=490)
QUIT
+21 SET ICDRG=$SELECT(ICDP25=1&($DATA(ICDS25(2))):489,ICDP25=1&($DATA(ICDS25(3))):490,1:ICDRG)
IF 'ICDGH&((ICDRG=489)!(ICDRG=490))
QUIT
+22 SET ICDRG=$SELECT(ICDP25=2&($DATA(ICDS25(1))):489,ICDP25=3&($DATA(ICDS25(1))):490,1:ICDRG)
IF 'ICDGH&((ICDRG=489)!(ICDRG=490))
QUIT
+23 SET ICDRG=$SELECT((ICDP25&(ICDOCNT=0)&('$DATA(ICDS25))):490,1:ICDRG)
IF 'ICDGH&(ICDRG=490)
QUIT
+24 if (ICDRG=488)!(ICDRG=489)!(ICDRG=490)
SET ICDRTC=0
+25 KILL ICDGH,ICDP25,ICDS25,ICDORNA
QUIT
CKMST ;MDC24 grouping; MS-DRG additions
+1 SET ICDAJ=0
FOR ICDS24K=1:1
SET ICDAJ=$ORDER(ICDS24(ICDAJ))
if ICDAJ=""
QUIT
+2 SET ICDS24K=ICDS24K-1
SET ICDS24L=0
FOR ICDI=1:1:8
if $DATA(ICDS24(ICDI))&(ICDI'=ICDP24)
SET ICDS24L=$SELECT($DATA(ICDS24(ICDI)):1,1:0)
+3 IF ICDOR["u"
SET ICDS24K=ICDS24K+1
+4 if ((ICDP24=0)&(ICDS24K<2))!((ICDP24>0)&('ICDS24L))
GOTO CKMSTE
+5 NEW CKMST
SET CKMST=0
+6 ;MS-DRG
IF ICDDATE>3070930.9
Begin DoDot:1
+7 SET ICDRG=$SELECT(ICDP24=0&(ICDS24K>1)&($DATA(ICDO24(1))):955,ICDP24>0&($DATA(ICDO24(1)))&(ICDS24L):955,1:ICDRG)
IF ICDRG=955
DO CKMSTE
SET CKMST=1
QUIT
+8 if ICDRG'=955
SET ICDRG=$SELECT(ICDP24=0&(ICDS24K>1)&($DATA(ICDO24(2))):956,ICDP24>0&($DATA(ICDO24(2)))&(ICDS24L):956,1:ICDRG)
IF ICDRG=956
DO CKMSTE
SET CKMST=1
QUIT
+9 if ICDRG'=956
SET ICDRG=$SELECT(ICDP24=0&(ICDS24K>1)&($DATA(ICDO24(3))):959,ICDP24>0&($DATA(ICDO24(3)))&(ICDS24L):959,1:ICDRG)
IF ICDRG=959
DO CKMSTE
SET CKMST=1
QUIT
+10 SET ICDRG=$SELECT(ICDP24=0&(ICDS24K>1):965,ICDP24>0&ICDS24L:965,1:ICDRG)
+11 if (ICDRG>954)&(ICDRG<966)
SET ICDRTC=0
End DoDot:1
if CKMST
QUIT
+12 ;CMS-DRG
IF '$TEST
Begin DoDot:1
+13 SET ICDRG=$SELECT(ICDP24=0&(ICDS24K>1)&($DATA(ICDO24(1))):483,ICDP24>0&($DATA(ICDO24(1)))&(ICDS24L):483,1:ICDRG)
IF ICDRG=483
DO CKMSTE
SET CKMST=1
QUIT
+14 if ICDRG'=483
SET ICDRG=$SELECT(ICDP24=0&(ICDS24K>1)&($DATA(ICDO24(2))):485,ICDP24>0&($DATA(ICDO24(2)))&(ICDS24L):485,1:ICDRG)
IF ICDRG=485
DO CKMSTE
SET CKMST=1
QUIT
+15 if ICDRG'=485
SET ICDRG=$SELECT(ICDP24=0&(ICDS24K>1)&($DATA(ICDO24(3))):486,ICDP24>0&($DATA(ICDO24(3)))&(ICDS24L):486,1:ICDRG)
IF ICDRG=486
DO CKMSTE
SET CKMST=1
QUIT
+16 SET ICDRG=$SELECT(ICDP24=0&(ICDS24K>1):487,ICDP24>0&ICDS24L:487,1:ICDRG)
+17 if (ICDRG>482)&(ICDRG<488)
SET ICDRTC=0
End DoDot:1
if CKMST
QUIT
CKMSTE KILL ICDAJ,ICDP24,ICDS24,ICDO24,ICDS24K,ICDO24,ICDS24L
+1 QUIT
CKNMDC ;non MDC drg's
+1 ;MS-DRG
IF ICDDATE>3070930.9
GOTO CKNMDC^ICDDRGXM
+2 if (ICDRG>479)&(ICDRG<483)
SET ICDRG=470
+3 ; ICD*18*1 - reorder drg 103 higher than all Pre-MDCs 480-83 & 495
+4 IF ICDRG=103
SET ICDRTC=0
QUIT
+5 SET ICDCDSY=$SELECT(ICDDATE'<$$IMPDATE^LEXU("10D"):30,1:1)
+6 ;use FY logic to resolve DRG if no FY defined user current FY
+7 NEW ICDDXFY
SET ICDDXFY=""
+8 ;Use DRG FY 05 logic
IF ICDDATE>3040930.9
Begin DoDot:1
+9 ;S ICDRG=$S($D(ICDOP(" 31.1"))!($D(ICDOP(" 31.21")))!($D(ICDOP(" 31.29")))&(($P($$ICDDX^ICDCODE(ICDDX(1),ICDDATE),"^",3)'["Y")!($D(ICDOP(" 96.72")))):541,1:ICDRG)
+10 ;I ICDRG=541&(($P($$ICDDX^ICDCODE(ICDDX(1),ICDDATE),"^",3))["Y") S ICDRG=542 S ICDRTC=0
+11 IF $DATA(ICDOP(" 39.65"))
SET ICDRG=541
QUIT
+12 IF $DATA(ICDOP(" 31.1"))!($DATA(ICDOP(" 31.21")))!($DATA(ICDOP(" 31.29")))
IF $TRANSLATE($PIECE($$ICDDX^ICDEX(ICDDX(1),ICDDATE,ICDCDSY,"I"),"^",3),";","")'["Y"!(($DATA(ICDOP(" 96.72"))))
SET ICDRG=542
+13 IF $DATA(ICDOP(" 31.1"))!($DATA(ICDOP(" 31.21")))!($DATA(ICDOP(" 31.29")))
IF $TRANSLATE($PIECE($$ICDDX^ICDEX(ICDDX(1),ICDDATE,ICDCDSY,"I"),"^",3),";","")'["Y"!(($DATA(ICDOP(" 96.72"))))
IF ICDOR["O"&(ICDOR'["z")&(ICDOR'["y")
SET ICDRG=541
End DoDot:1
IF ICDRG=541!(ICDRG=542)
SET ICDRTC=0
QUIT
+14 ;Use DRG FY 04 logic
IF ICDDATE<3041001
Begin DoDot:1
+15 SET ICDRG=$SELECT($DATA(ICDOP(" 31.1"))!($DATA(ICDOP(" 31.21")))!($DATA(ICDOP(" 31.29")))&(($TRANSLATE($PIECE($$ICDDX^ICDEX(ICDDX(1),ICDDATE,ICDCDSY,"I"),"^",3),";","")'["Y")!($DATA(ICDOP(" 96.72")))):483,1:ICDRG)
IF ICDRG=483
SET ICDRTC=0
End DoDot:1
if ICDRG=483
QUIT
+16 SET ICDRG=$SELECT(ICDOR["l":480,1:ICDRG)
IF ICDRG=480
SET ICDRTC=0
QUIT
+17 IF ICDRG=512!(ICDRG=513)
SET ICDRTC=0
QUIT
+18 ;check for lung tx
SET ICDRG=$SELECT(ICDOR["r":495,1:ICDRG)
IF ICDRG=495
SET ICDRTC=0
QUIT
+19 ;check for heart tx
SET ICDRG=$SELECT(ICDOR["q":103,1:ICDRG)
IF ICDRG=103
SET ICDRTC=0
QUIT
+20 SET ICDRG=$SELECT(ICDOR["B":481,1:ICDRG)
IF ICDRG=481
SET ICDRTC=0
QUIT
+21 SET ICDRG=$SELECT($DATA(ICDOP(" 30.3"))!$DATA(ICDOP(" 30.4")):482,1:ICDRG)
IF ICDRG=482
SET ICDRTC=0
QUIT
+22 SET ICDRG=$SELECT(ICDOR["t"&($TRANSLATE($PIECE($$ICDDX^ICDEX(ICDDX(1),ICDDATE,ICDCDSY,"I"),"^",3),";","")["Y"):482,1:ICDRG)
IF ICDRG=482
SET ICDRTC=0
QUIT
+23 QUIT
+24 ;
+25 ;
CHKMDC4 ;MDC 4 drg's
+1 ;MS-DRG
IF ICDDATE>3070930.9
Begin DoDot:1
+2 IF (ICDMDC=4!(ICDMDC=98))
IF (ICDOR["f")
SET ICDRG=168
+3 IF ICDDRG=983
IF $GET(ICDMDC)=5
IF $DATA(ICDOP(" 86.06"))
SET ICDRG=264
+4 ;ICD*18*5
IF ICDDRG=983
IF $GET(ICDMDC)=5
IF $DATA(ICDOP(" 92.27"))
IF ICDNOR=1
SET ICDRG=264
End DoDot:1
+5 ;CMS-DRG
IF '$TEST
Begin DoDot:1
+6 IF (ICDMDC=4!(ICDMDC=98))
IF (ICDOR["f")
SET ICDRG=76
+7 IF ICDDRG=468
IF $GET(ICDMDC)=5
IF $DATA(ICDOP(" 86.06"))
SET ICDRG=120
+8 ;ICD*18*5
IF ICDDRG=468
IF $GET(ICDMDC)=5
IF $DATA(ICDOP(" 92.27"))
IF ICDNOR=1
SET ICDRG=120
End DoDot:1
+9 QUIT
